EMDR: Research prompts acceptance
In 1987, Francine Shapiro, Ph.D., senior research fellow emeritus at the Mental Research Institute in Palo Alto, Calif., director of the EMDR Institute and founder of the EMDR Humanitarian Assistance Program, developed a new therapy that both intrigued and puzzled clinicians. Eye movement desensitization – in 1991, reprocessing was added to the technique – (EMDR) gained some ready supporters, while drawing skepticism from others. Today, this therapy, which has been the subject of many research studies, has become more widely accepted for use in the treatment of mental health, especially trauma diagnoses.
Kathleen Wheeler, Ph.D., APRN, FAAN, professor at the School of Nursing at Fairfield University in Connecticut and president-elect of EMDRIA (EMDR International Association), became aware of EMDR in the late ‘90s when a friend introduced her to the therapy. A bit skeptical at first, she tried a session and “was struck by the power of it.” This experience prompted her to become trained so she could use EMDR in her practice.
Wheeler explains that EMDR involves eight phases, i.e., history; preparation for memory processing; assessment; desensitization; installation; body scan; closure; re-evaluation. She points out that to achieve optimal results, research has found that the closer the protocol is followed, the better the outcome.
The eye movement component has raised some eyebrows, but Wheeler says, “The use of eye movements has a solid research base, but other types of bilateral stimulation are also effective, such as tapping and sound.”
According to Wheeler, no one really knows for sure how any psychotherapy works. However, EMDR seems to allow for adaptive resolution of disturbing life events. “Theories about why it is effective include that EMDR interferes with working memory processes and that EMDR facilitates access to adaptive memory, similar to the REM phase of sleep when the brain processes the day’s residue,” she says. “Disturbing life events or memories are stored in a fragmented form and EMDR facilitates the reconnections of these memory fragments. The brain knows where it needs to go to make the neural connections for healing to occur. The therapist facilitates the process.” She explains that EMDR is a client driven treatment. “Any time they want to stop, they can.”
EMDR has been found to be safe for most patients, notes Wheeler, however, therapists need to be skilled in working with the population for whom they are using the therapy. “For example, there are guidelines for using EMDR with highly dissociative clients and, in the hands of an experienced EMDR therapist who is skilled in working with this population, EMDR can be very helpful,” she says.
While EMDR is researched and used most widely for PTSD, Wheeler points out that clients with other diagnoses, such as pain, depression, anxiety, relationship issues, eating disorders and many other mental health problems may also be helped. Since many symptoms of mental illness are because of adverse life experiences, EMDR works well with psychiatric disorders other than PTSD. EMDR is both a stand-alone treatment approach, as well as an integrative psychotherapy, so that other interventions may be used concurrently with EMDR.
For skeptics, Wheeler points to the research. She indicates that more than 27 randomized clinical trials have shown EMDR to be effective for PTSD and adds that the American Psychiatric Association, the Veterans Administration Department of Defense (VA-DOD) and many other national and international practice guidelines have approved EMDR as a Level A treatment for this disorder. “A Kaiser Permanente study found that after six sessions, 100 percent with a single trauma and 77 percent with multiple trauma events no longer had PTSD,” she says. “This is a well researched treatment and compares favorably to other treatments for PTSD. It’s good to be skeptical, but people should read the research.”
Richard J. McNally, Ph.D., professor and director of clinical training at Harvard University, is one such cynic who initially viewed EMDR as an “intractable problem,” citing no convincing evidence of effectiveness when compared to other treatments. However, colleagues Marcel A. van den Hout, Ph.D., and Iris M. Engelhard, Ph.D., both professors of clinical psychology at Utrecht University in the Netherlands, changed his mind with their extensive research into the therapy. After conducting several studies and meta-analyses, these psychologists determined that EMDR does indeed tax working memory where currently active information used to perform cognitive operations is located. They surmise that performing two tasks simultaneously, i.e., recalling a memory and making eye movements at the same time, requires working memory capacity, leaving less room for the memory, thus making it less vivid and less emotional.
After considering this research, McNally is convinced that these “solid scientific explanations offer a visual sketchpad of memory.” He says, “I have to follow the data.”
Much like Wheeler, Larry Hall, M.A., psychologist-master in private practice in South Burlington, Vt., became aware of EMDR after learning about the therapy. “I’d been a licensed psychologist for seven years, enough time to get my feet wet and see the shortcomings of traditional psychotherapy,” he says. “I had an inkling that more of human behavior had to do with the physiology in the brain.” After taking Level I training, a three-day intensive weekend that involved theory, practice and technique, he added EMDR to his existing specialties of neurofeedback and cranial electric stimulation.
Hall dubs EMDR “dual attention theory,” which is consistent with the findings of van den Hout and Engelhard and other researchers. “It is virtually impossible to pay attention to two things at the same time. By switching gears quickly, you shift the arousal state. Clients with PTSD are stuck and can’t switch gears,” he says. “The memories will always be there, but [with EMDR] you have practice getting into the moment.”
Although EMDR works relatively quickly, Hall notes that on occasion a “tune-up” may be necessary. “Life happens. An event might exacerbate the original trauma,” he says.
Based on research, scientific data and clinical practice, Hall believes psychology of the future will involve more study of the brain. “In order to remain viable, the science has to evolve and look at different techniques to access different problems,” he says. “Psychologists of the future will be brain coaches, rather than analysts.”